Cryosurgery after chemoembolization for hepatocellular carcinoma in
patients with cirrhosis.
Clavien PA, Kang KJ, Selzner N, Morse MA, Suhocki PV.
Division of Hepatobiliary Surgery and Liver Transplantation,
Department of Surgery, Duke University Medical Center, Durham, NC,
Most cirrhotic patients with hepatocellular carcinoma
(HCC) are not candidates for resection. Transarterial chemoembolization
(TACE) may ablate a significant portion of the tumor but has a high
rate of recurrence. Cryosurgery may permit successful ablation of
hepatic tumors but can be complicated by postoperative hemorrhage
and is also associated with a significant risk of recurrence. The
combination of the two techniques might be beneficial. We evaluated
in a prospective study the safety and efficacy of this combination
in cirrhotic patients with unresectable HCC. Fifteen patients were
included in this study. All but one patient underwent one or several
sessions of TACE before cryosurgery. Cryoablation was successfully
performed in each patient. The patient who did not undergo preoperative
TACE required reoperation for hemorrhage. Another patient with Child-Pugh
class B cirrhosis died postoperatively of hepatic and multiorgan
failure. At a mean follow-up of 2.5 years, three patients had recurrence
of disease, and 13 of 15 patients were alive with the longest survival
time being 5 years. The actuarial survival rate at 5 years was 79%.
Cryosurgery after TACE is feasible in cirrhotic livers with HCC
and can increase the cure rate in large tumors. TACE may reduce
the risk of hemorrhage after cryosurgery but can increase the risk
of hepatic failure in patients with poor hepatic function.
PMID: 11986024 [PubMed - indexed for MEDLINE]